Amazon Update

At this time, we are not adding any Amazon Partners. Thank you for your interest.

Business Partnership Application

Thank you for your interest in becoming an authorized re-seller with us.

Please fill out the form below. After we receive your application one of our reps will contact you to discuss potential opportunities together.

Company Name:

Primary Contact Name (Full Name):

Primary Contact Title:

Email Address:

Business Phone Number:

Mailing Address:

City:

State/Province:

ZIP/Postal Code:

Country:

Company Website:

Total Company Annual Sales (USD $): - Select Range - Less than $10000 $10000 - $25000 $25000 - $75000 $75000 - $100000 $100000 - $500000 $500000 - $1000000 $1Million - $5Million $5Million+

Company Total Employees:

Number of Years in Business:

Please List where you plan to sell Bondic^®:

How Many Units Are you Interested In For Your Initial order: - Select Units - 25 - 50 100 - 250 250 - 500 500 - 1000 1000 - 5000 5000 - 10000 10000+

Notes: